Soft tissue augmentation can be temporary or permanent. Temporary corrections can be achieved by lifting (e.g. face lifting), fat or collagen injections. Permanent corrections have been suggested through the use of homogenic and alloplastic implants. Homogeneous implants can have absorption problems and further incur disease transmission problems.
The properties of various synthetic implant materials have been reported when used in facial augmentation procedures, particularly for reconstructions. Synthetic implants have been used in augmentation procedures. The materials used include solid, medical-grade silicone rubber ("Silastic," available from Dow-Corning Corp., Midland, Mich.), braided, multifilament PET ("Mersilene," available from Ethicon Corp., Summerville, N.J.), polyamide mesh ("Supramid," available from S. Jackson, Inc., Alexandria, Va.), polytetrafluoroethylene resin ("Teflon," available from C. R. Baird, Inc., Billerica, Mass.), polytetrafluoroethylene carbon ("Proplast," available from Vitek, Inc., Houston, Tex.), hydroxyapatite (available from Integrated Orbital Implants, San Diego, Calif.), and expanded, fibrillated polytetrafluoroethylene, or PTFE ("Gore-Tex," available from W. L. Gore, Phoenix, Ariz.).
Thus, Stucker reports firming rolling polyamide mesh and placing the implants in incised locations to correct nasal dorsal deformities, for chin augmentation, or for underdeveloped maxilla associated with cleft lip nose. Stucker, "Use of Implantation in Facial Deformities," Laryngoscope, 87, pp. 1523-1527 (1977). Later, Stucker and coauthors reported further facial contouring procedures, again using polyamide mesh, which was folded into layers and then tightly rolled. These implants were used to augment the nasal dorsum through incisions to prepare the recipient site. Stucker et al., "Technical Aspects of Facial Contouring Using Polyamide Mesh," Otolaryngol. Clin. North Am., 15:1, pp. 123-131 (1982).
However, polyamide when implanted gives rise to some tissue reaction and undergoes some hydrolytic degradation that results in a gradual loss of tensile strength. Thus, Beekhuis describes use of Mersilene mesh as an alternative dorsal nasal filler in saddle nose deformities, for chin implants, and the like reconstructive surgical procedures. Beekhuis, "Mersilene Mesh to Augment the Nasal Bridge," Am. J. Cosmetic Surg., 3:2 (1986).
Maas et al. compared the gross behavior of various currently used implant materials for facial bone augmentation at different sites in dogs. The authors concluded that the site of implantation and implant movement were important factors in determining the nature of the tissue response and the fate of implants. Maas et al., "Comparison of Biomaterials for Facial Bone Augmentation," Arch. Otolaryngol. Head Neck Surg., 116, pp. 551-556 (1990).
Several authors have recently discussed the use of Gore-Tex implants. Thus, Rothstein et al. have used patches of the PTFE material for saddle nose deformities in nasal augmentation operations. Rothstein et al., "The Use of Gore-Tex Implants in Nasal Augmentation Operations," EN Technology, pp. 40-45, (1989). Similarly, Waldman reports use of Gore-Tex soft tissue patches as dorsal implants where the patch (or layers of patches) was placed over incisions and intranasal and extranasal incisions closed. Waldman, "Gore-Tex for Augmentation of the Nasal Dorsum: A Preliminary Report," Anal. Plas. Surg., 26:6 (1991). Mole has used patches or strips of the material inserted by a needle-like instrument with the implant kept in place using a transfixing cutaneous needle. Mole, "The Use of Gore-Tex Implants in Aesthetic Surgery of the Face," Plas. Reconst. Surg., 90:2, pp. 200-206 (1992).
However, the strips, patches, sandwiches, and tightly rolled forms of implants previously and presently used have had various drawbacks and disadvantages, such as the necessity for relatively large incisions to achieve implantation and the limited amount of tissue ingrowth.